Schools and Health Our Nation's Investment (1997) / Chapter Skim
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2 Evolution of School Health Programs
2 Evolution of School Health Programs
Pages 33-80
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From page 33... ...
An understanding of the evolution of school health programs gives insight into how educational, political, and societal issues as well as health issues have influenced these programs over the years and provides lessons for the future development of school health programs. School Health Through the Early Twentieth Century During the colonial period, only limited attention was paid to any aspect of school health.
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From page 34... ...
Although the schools of this period had the potential to confront and control communicable disease, no doubt they also contributed to the spread of disease. In the late 1860s and early 1870s, the New York City Board of Health instituted a program of sanitary inspections of all public schools twice a year.
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From page 35... ...
In 1906, Massachusetts made medical inspection compulsory in all public schools, a step that ushered in broad-based programs of medical inspections in which school nurses and physicians participated. Legislative mandates became the means of ensuring medical inspections, and legislation continues to this day to be the basis for many elements of school health programs.
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From page 36... ...
Throughout the late nineteenth century and early twentieth century, the temperance movement also had an influence on school health programs, stressing that children should learn about the effects of alcohol, tobacco, and narcotics on the human system. As a result of this effort, a 1The list of these health chores gives a revealing look at what were considered to be significant health issues for children in that era.
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From page 37... ...
The early leaders in the physical education movement had medical degrees, and there was much discussion about the new profession of physical education being a blend of the medical and educational fields. Physical training was often associated with instruction in temperance and hygiene; other topics of focus in the early years of physical education included anthropometrical measurement, gymnastic systems, athletics, folk dancing, and military drill although military activities fell out of favor around the turn of the century (Lee and Bennett, 1985~.
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From page 38... ...
During the years immediately following World War I, the image of modern school health programs began to emerge. The Influence of Reports and Publications Following World War I, the Child Health Organization was one of the most active groups devoted to the health of children, and the organization conducted "a nationwide campaign to raise the health standard of the American School Child." This distinguished group began as an outgrowth of the Committee on War Time Problems of Childhood, and its members were leaders in the fields of medicine, education, public health, psychology, and other arts and sciences.
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From page 39... ...
It is ironic that almost 70 years later, coordination of these programs is still considered lacking. Early in the 1920s, the NEA-AMA Joint Committee on Health Problems in Education reported the results of a nationwide survey of the status of health education in 341 city schools.
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From page 40... ...
Nationally and at state levels, maternal and child health agencies sponsored numerous conferences to improve school health services by linking them to other community health efforts. Particularly significant health education reports include Suggested School Health Policies, published by the National Committee on School Health Policies of the National Conference for Cooperation in Health Education, and Health Appraisal of School Children, published by the NEA-AMA Joint Committee on Health Problems in Education.
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From page 41... ...
During the following decades, the health education curriculum became stabilized and more fully developed. Topics such as nutrition, personal health habits, diseases, exercise, alcohol and tobacco, family health, and sex education became common.
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From page 42... ...
Although health education was considered an important and legitimate function of the school, when it came to providing services the school acted primarily as a link between students and the community's health services resources. Typically, a school nurse and/or aide, sometimes under the supervision of a part-time physician, was responsible for first aid, immunization, screening, referral, recordkeeping, and follow-up.
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From page 43... ...
Another early demonstration conducted in 1917 in Framingham, Massachusetts, was primarily concerned with tuberculosis prevention and resulted in increased school appropriations for health education and physical education; the project was financed by the Metropolitan Life Insurance Company and carried out by the National Tuberculosis Association. A number of school health demonstration projects and studies were carried out during the 1920s, 1930s, and 1940s.
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From page 44... ...
of the current National Council for the Accreditation of Teacher Education guidelines on the preparation of health education specialists, and in the development of guidelines on the health education preparation of elementary teachers by AAHE and the American School Health Association. In 1950, standards for school health services were
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From page 45... ...
The introduction of school nurse practitioners into schools resulted in reaching students in need of primary care, an increase in problem resolution rates, and greater accuracy in excluding students from school for illness and injury (Hilmar and McAtee, 1973; Kohn, 1979; Silver et al., 1976~. The most significant school health education initiative of the 1960s was the School Health Education Study.
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From page 46... ...
Public Health Service's Healthy People 2000 initiative, which includes a set of nearly 300 national health promotion and disease prevention objectives to be achieved by the year 2000.
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From page 47... ...
, which calls for all adolescents aged 11 to 21 to have an annual preventive services visit to a physician who will address both the biomedical and the psychosocial aspects of health, with emphasis on health guidance and screening for risky behaviors such as sexual activity, substance abuse, eating disorders, learning difficulties, abuse, and emotional problems (American Medical Association, 1992~; · since the beginning of 1994, a number of national conferences and reports have focused on the importance of improving access to comprehensive health and social services for children and families as a means of improving the health, welfare, and educational achievement of children;3 30ne important event was '~Principles to Link By," a conference in early 1994 attended by over 50 national organizations, including such wide-ranging groups as the American
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From page 48... ...
, and school foodservice and nutrition practices (American School Food Service Association, 1995~. What Have We Learned from the History of Health Programs in the Schools?
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From page 49... ...
For example, at the turn of the twentieth century when the New York State Legislature proposed a bill to provide for sanitation, ventilation, and fire protection in schoolhouses in cities with populations of more than 5,000, the bill was easily defeated with charges that "it smacked of interference and paternalism in local affairs" (Duffy, 1974~. These charges are echoed today as some individuals and communities resist directives about school health programs imposed from above, especially directives pertaining to such controversial aspects of programs as sex education or mental health counseling.
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From page 50... ...
In its interim statement, the committee considered these issues, and the following sections extends that discuss~on. Goals and Desired Outcomes The committee believes that the overarching goals of a comprehensive school health program are to enable all students to achieve and maintain an optimal state of health and well-being, reach their full academic potential, and develop into healthy productive adults who take personal responsibility for their own health.
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From page 51... ...
According to recent common usage, a CSHP refers to an overall school health program, of which school health education and school health services are each components. However, some use the term "comprehensive school health education" to refer to an overall program and consider school health services to be a component of comprehensive school health education.
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From page 52... ...
Originating in the early 1900s and evolving through the 1980s, this model, as shown in Table 2-1, defines a school health program as consisting of the following three basic components: 1. health instruction, accomplished through a comprehensive health education curriculum that focuses on increasing student understanding of health principles and modifying health-related behaviors; 2.
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From page 53... ...
5. Health promotion for staff provides health assessments, education, and fitness activities for faculty and staff, and encourages their greater commitment to promoting students' health by becoming positive role models.
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From page 54... ...
SOURCE: New Mexico Healthier Schools: A Model of Comprehensive School Health, State of New Mexico.
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From page 55... ...
This model is shown in Figure 2-2. According to this model, the first steps in developing a CSHP Child/Youth Health Status ~ ~ Educational Achievement /\ Family/ Friends School School health services School health education School health environment Health promotion efforts School physical education School nutrition School counseling School/worksite health promotion / \ Media Educational Electronic media Print media Commercials Regulation of programming Community Health services Social programs Church programs Health promotion programs Voluntary health agencies Mental health services Worksite health promotion University programs \ FIGURE 2-2 Family-school-community model.
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From page 56... ...
According to this model, a comprehensive school health program focuses on priority behaviors that interfere with learning and long-term well-being; fosters the development of a supportive foundation of family, friends, and community; coordinates multiple programs within the school and community; uses interdiscipli
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From page 57... ...
Reprinted with permission. American School Health Association, Kent, Ohio.
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From page 58... ...
Each participating school develops programs that include health education, a health-promoting environment, and linkages with families and community resources. Collaboration at all levels is emphasized, and best practices are shared and disseminated through cross-border workshops and major international meetings.
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From page 59... ...
The charge to 5Members of the coalition are the American Public Health Association, School Health Education and services section and the Public Health Education and Health Promotion section; American College Health Association; American School Health Association; Association for the Advancement of Health Education; American Alliance for Health, Physical Education, Recreation and Dance; Association of state and Territorial Directors of Public Health Education; society for Public Health Education, Inc.; and society of state Directors of Health, Physical Education and Recreation.
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From page 60... ...
It should also include, but not be limited to, guidance and counseling, physical education, food service, social work, psychological services, and employee health promotion. The Committee's Provisional Definition After review of previous models and definitions, the committee proposed the following provisional definition of a CSHP, which was presented in its interim statement (IOM, 1995~: A comprehensive school health program is an integrated set of planned, sequential, school-affiliated strategies, activities, and services designed to promote the optimal physical, emotional, social, and educational development of students.
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From page 61... ...
When properly designed and sensitive to community concerns, CSHPs provide family support by reinforcing community values and providing access to health and social services, both for students and possibly for other family members. Determine means to come to a decision by investigation, reasoning, or calculation, to settle or decide by choosing among alternatives or possibilities.
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From page 62... ...
The definition is flexible, not overly prescriptive, and emphasizes what the committee believes are the crucial features of a CSHP family and community involvement, multiple interventions, integration of program elements, and collaboration across disciplines. The various definitions and models of CSHPs are not separate and distinct, and considerable commonality exists among them.
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From page 63... ...
Each of these components has its own wide literature6 that should be consulted for an in-depth understanding of that component. 6Guidelines for Comprehensive School Health Programs from the American School Health Association (1994)
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From page 64... ...
Guidelines for school health programs to promote healthy eating and guidelines for school and community health programs to promote physical activity among youth were scheduled to be released in 1997, and guidelines for school health education were under development. · Principles and Practices of Student Health, edited by Wallace et al.
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From page 65... ...
Extracurricular sports and physical fitness activities are promoted for all students, and healthful foods are sold in the school lunch, school breakfast, and a la carte options in the school cafeteria, as well as through vending machines, school events, or fund-raising drives. Schedules are designed not merely to improve efficiency but also to reduce stress; for example, class release times may be staggered to minimize crowding in halls and avoid unnecessary sources of conflict, and lunch periods may be scheduled to provide adequate time to enjoy healthful meals.
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From page 66... ...
The family support team works full-time in each school and consists of social workers, attendance workers, and a parent liaison
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From page 67... ...
Another benefit of staff health promotion may be a decrease in group health insurance costs. Healthy People 2000 calls for employee health promotion for all worksites (U.S.
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From page 68... ...
Physical Education. Physical education involves a planned, sequential, developmentally appropriate, K-12 curriculum that provides cognitive and affective content and physical activity.
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From page 69... ...
The October 1995 issue of the Journal of School Health is devoted to a summary report of SHPPS findings and includes separate analyses of school health education (Collins et al., 1995~; school physical education (Pate et al., 1995~; school health services (Small et al., 1995~; school health services (Small et al., 1995~; school foodservice (Pateman et al., 1995~; and school health policies prohibiting tobacco use, alcohol and other drug use, and violence (Ross et al., 1995~.
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From page 70... ...
It should be emphasized that the inclusion of health topics in other curricular areas should enhance, but not replace, the health education curriculum. Services Presented below is a brief summary of the types of services typically found in school health programs.
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From page 71... ...
School health services are provided by nurses, physicians, dentists, and other allied health personnel in settings ranging from a health aide's office in the school to a full-blown school-based clinic providing a wide range of primary care services. Depending on the community, certain basic health services may be considered the responsibility of the school system, such as the provision of school nurses or health aides.
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From page 72... ...
Nutrition education should be part of classroom health education, and nutrition should be introduced into other subjects such as science, physical education, and home economics. In providing a variety of nutritious and appealing meals, the school foodservice serves as a laboratory to reinforce the lessons learned in the classroom.
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From page 73... ...
Comprehensive school-affiliated family services are increasingly considered to be an important means for reaching families and for improving academic, health, and social outcomes for studentsl° (American Academy of Pediatrics, 1994a, 1994b; 10As examples, the Goals 2000 legislation calls for states to involve parents and other community representatives in developing the state's educational improvement plan, which should include such strategies as increasing the access of all students to health and social services in convenient sites designed to provide "one-stop shopping" for parents and students. The Improving America's Schools Act, which reauthorizes the Elementary and Secondary Education Act (ESEA)
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From page 74... ...
To examine this premise further, a paper on integrating school and community health efforts was commissioned; the paper is found in its entirety in Appendix A (Note that in this paper the author uses the terminology "comprehensive school health education" to refer to what the committee has called a "comprehensive school health program.")
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From page 75... ...
Research 1lThe committee did not attempt to carry out a national search for comprehensive school health programs. However, informal feedback from the Infrastructure States demonstration sites for comprehensive school health programs sponsored by DASH/CDC indicates that progress is being made, but CSHPs are not yet a widespread institutionalized phenomenon.
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From page 76... ...
Paper presented at the Institute of Medicine Workshop, Integrating Comprehensive School Health Programs in Grades K-12, Washington, D.C., May. Allensworth, D.D., and Kolbe, L.J.
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From page 77... ...
1994. Guidelines for Comprehensive School Health Programs.
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From page 78... ...
1995. The Status of School Health: Annex 1 to the Working Paper of the World Health Organization Expert Committee on Comprehensive School Health Education and Promotion.
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From page 79... ...
1964. School Health Education Study: A Summary Report.
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From page 80... ...
1991. Healthy People 2000: National Health Promotion and Disease Prevention Objectives.
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